Name: transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction
Uploaded: 2017-10-13T12:30:00.000+00:00
Duration: 7 min 30 s
Description: Watch this Scientific Journal Video about Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction at JoVE.com

德意志 Forschungsgemeinschaft (德国研究协会;为 2240 "(淋巴) 血管生成和细胞免疫在眼睛炎症性疾病" 到台基;他 6743/2-1 和他 6743/3-1 到台基), 科隆大学 GEROK 计划克尔克和台基。我们感谢 Dr. Kühner 的技术支持。

在这一过程中, 需要得到知情同意, 并已为在德国科隆科隆大学眼科科接受过手术的每一位患者获得了批准。所有检查和手术干预都是按照国家法律和1975年的赫尔辛基宣言在其当前版本中执行的. 
 注意: 除非另有说明, 否则指令将始终仅指执行过程的一侧。使用灭菌设备. 
 1. 患者准备 <ol> <li> 执行彻底的眼科检查 (特别注意眼睑、上、下泪和撕裂引流), 包括冲洗和探查潘多 10.
	<ol> <li> 对于标准化灌溉, 将 Bangerter 探针插入上部, 随后将泪。先将其垂直插入, 然后将其倾斜到寺庙的水平位置, 以跟随小的生理形成。当探头就位时, 仔细注射生理盐水以检测泪道阻塞. 
		注: 在 infrasaccal 潘多, Bangerter 套管很容易到达侧壁, 没有弹性阻力 (和 #34; 硬停止和 #34;)。试图灌溉将导致对侧反流通过对面的泪没有任何液体到达病人和 #39; 咽 10 . </li>
	</ol> </li> <li> 排除急性感染、撕裂引流系统肿瘤以及外伤、先天性或 presaccal 梗阻。
	<ol> <li> 排除急性感染, 寻找痛苦的发红, 肿胀或脓性流出的泪引流。排除肿瘤, 寻找惰性肿胀, 溃疡或色素沉着。Presaccal 梗阻导致 Bangerter 探针进入泪腺囊 (#34; 软停止和 #34;)。先天性和外伤性梗阻可以排除患者病史 10 , 19 , 20 。
	</ol> </li> <li> 排除鼻腔 rhinological 的病态, 如严重的隔膜偏差。这应该是采取的病人和 #39 的历史, 并与 rhinological 检查鼻腔腔的结合 21 . </li>
	<li> 将患者置于全身麻醉下, 如静脉注射异丙酚、瑞芬太尼和阿曲库, 用于诱导和吸入 desfluran 加静脉注射瑞芬太尼用于维持, 使用标准的重量调整剂量 10 . 插管应进行, 但也可以使用喉罩. 
	注: 麻醉药和剂量可能不同的诊所之间。激光辅助 DCR 不需要特定的麻醉方案. </li>
</ol> 2。激光辅助 DCR <ol> <li> 将视频辅助内窥镜插入鼻腔, 通过鼻孔仔细推进。通过略微倾斜内窥镜向侧鼻壁可视化中鼻甲前缘. </li>
	<li> 将激光设备和激光设置设置为正确的值。戴上防护眼镜
	<ol> <li> 将激光光纤 (直径400和 #181; m) 连接到二极管激光器 (波长 810 nm)。设置二极管激光器设置为 6-8 W, 200 毫秒脉冲持续时间, 100 毫秒博览会暂停. </li>
		<li> 将激光光纤放入手片中进行机动和通过钝套管。让 2-3 毫米的纤维坚持在套管的尖端. </li>
		<li> 通过将激光纤维放在木铲上进行碳化, 并在几秒钟内应用镭射能量, 直到尖端足够黑. 
		注意: 这将限制不必要的能量分布到泪腺囊的组织. </li>
	</ol> </li> <li> 在侧鼻壁上正确定位激光纤维。
	<ol> <li> 使用泪腺探针放大和 #160; 下泪 ( 图 2a )。先将探针插入垂直方向, 然后在进一步向泪腺囊推进前将探头带入水平方向。这将允许在下一步中顺利插入激光光纤. </li>
		<li> 将激光光纤插入下小 ( 图 2b , 2c )。先将其垂直插入, 然后将其倾斜到寺庙的水平位置, 以跟随下部小的生理形成. </li>
		<li> 小心地将激光纤维推进到泪腺囊中, 直至触及侧鼻壁, 即内侧泪 saccal 壁。在那里, 以前的方向瞄准尖端, 使它指向中鼻甲的前缘. </li>
		<li> 通过在中鼻甲前边缘的高度监视瞄准光束的 transluminescence ( 图 2d ), 验证正确的定位内. </li>
	</ol> </li> <li> 通过将脉冲激光能量应用于鼻腔壁来创建足够的鼻泪旁路。
	<ol> <li> 应用激光能量 (使用上述参数设置), 保持与墙壁的恒定接触而不受压力, 瞄准中鼻甲的前缘。激光将直接在它前面蒸发组织, 创建一个鼻泪旁路 ( 图 2d , 2e )。
		注: 所需的总能量范围介于 0.9-1.8 焦, 并趋于不同的病人之间. </li>
		<li> 确保光纤笔尖没有主动按下墙壁。注意不要让笔尖滑回金属套管, 因为这会导致金属发热引起的热损伤。也避免侧向运动, 因为尖端可以折断. </li>
		<li> 在穿透侧壁时, 将激光纤维向后拉一点, 并通过仔细地将边缘以圆形方式汽化来扩大口口。尽量创建尽可能大的旁路 ( 图 2f ). </li>
		<li> 针对口口的总直径为5毫米. </li>
		通过仔细地缩回设备, <li> 停止应用能量并将激光纤维与手片和套管一起取出. </li>
	</ol> </li> <li> 通过使用 Bangerter 探头在1.1.1 中描述的盐水冲洗来验证口口的通畅性。如果发明了一个专利口, 成功的灌溉应该是可见的内. </li>
	<li> 删除 Bangerter 探测器. </li>
	<li> 放置硅管 ( 图 2g )。
	<ol> <li> 通过下泪, 插入一个 monocanalicular 硅管, 并小心推进它, 直到领先的金属尖端通过骨口和凸出到鼻腔. </li>
		<li> 使用 Blakesley 钳从鼻腔内抓取尖端, 并将硅管拉出机头并进入位置 ( 图 2h ). </li>
		<li> 使用一对剪刀来缩短硅管。最终不应该被伸出鼻子. </li>
		<li> 通过上部小执行硅胶插管 (以下步骤2.7.1 通过 2.7.3) ( 图 2h ). </li>
	</ol> </li> <li> 删除鼻内窥镜. </li> </ol>
 3. 术后护理和随访 <ol> 手术后, 用抗生素启动治疗e 滴 (如氧氟沙星), 充血滴眼液 (如 xylometazolin) 和甾体滴眼液 (如醋酸泼尼松龙)。抗生素可以在一周后停止, 而类固醇和充血的眼药水应该在一个月的过程中慢慢断奶. </li>
	<li> 手术后六周和三月随访。寻找症状的解决, 硅管脱垂, 感染和分泌. </li>
	<li> 在手术后三月内取出硅管, 只需在点的高度抓住 T 形末端, 然后小心地拉出. </li>
</ol>

<ol>
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没有利益冲突。

Transcanalicular 激光辅助 DCR 如上所述是一个相当快速, 微创的方式来治疗绝对 infrasaccal 鼻泪管阻塞有效地不需要皮肤切口, 从而节省不仅皮肤, 而且内侧眦肌腱和生理小泵的机理。虽然该程序非常适合于患有鼻泪管阻塞的患者, 但非特发性狭窄的病症不符合此程序。这是由于, 部分, 因为它不允许全面检查泪腺囊或活检不典型的结果是采取19,20,<sup cl...

Infrasaccal 原发性后天性鼻泪管阻塞 (潘多) 是一种常见的疾病, 在 middle-aged 和老年患者导致慢性溢和睑, 以及复发或慢性泪囊炎。最常见的情况是, 患者会出现一个或两个鼻泪导管的 infrasaccal 阻塞, 导致泪液引流不足。
在治疗潘多, 外部泪囊鼻腔切除术 (DCR) 仍然被认为是金标准, 尽管这个过程历史上追溯到100年前, 当它是第一次执行1。经皮下切口和泪囊鼻壁的制备, 用钻头制造出通向鼻腔的骨口, 绕过阻塞的导管。已报告此方法2,3的功能成功率超过85%。然而, 这些结果是以执行一个相对侵入性的手术的成本来承担风险的眼睑的内侧结构包括生理小泵机制4,5 , 并可能给患者留下不受欢迎的疤痕, 虽然现代 nasojugal 皮肤切口有改善的结果。这些风险是潜在的可避免通过执行较少侵入技术或选择一个鼻的方法。
为了规避侵入性手术, 在微创泪流再通领域做了大量的工作。两种方法, 特别是建立了潜在的第一步程序: microdrill dacryoplasty 和激光辅助 dacryoplasty。这些程序是基于 transcanalicular 内窥镜的泪引流系统, 可以执行治疗段膜狭窄的鼻泪管。虽然只有微创和特点的快速 reconvalescence, 这些正值技术的共同缺点是相对较低的功能成功率关于长期的结果6,7,8,9。
为了填补这些第一步程序和外部 DCR 之间的空白, 作为一种明确的治疗方法, 最近已经制定了新的办法。最有希望的是激光辅助 DCR 治疗绝对 infrasaccal 潘多。像所有上述的方法, 病人建议被置于全身麻醉的程序。二极管激光纤维通过小插入, 然后进入泪囊。接下来, 将激光能量应用到侧鼻壁上, 直到形成一个骨口, 在中鼻甲的前边缘的高度连接到鼻腔,10,11。持续的视觉控制一直使用鼻内窥镜。新形成的吻合口用作泪引流的旁路。成功的灌溉后, bicanalicular 硅插管, 以防止早期疤痕的新形成的口。术后治疗包括充血、甾体和抗生素滴眼液, 分别预防肿胀、炎症和感染。
手术时间和 reconvalescence 一般短于外部 DCR (10-25 分钟的激光辅助 DCR vs 35-75 分钟外 DCR)。并发症率较低, 最常见的是离散肿胀的眼睑和硅胶管脱垂。小感染和热损伤是罕见的事件10。一年功能成功率为 74-88% 已报告10,11,12,13,14,15,16, 17,18, 因此在外部 DCR 的后面, 不受外部手术方法的不利因素的困扰。然而, 长期的结果仍有待提供。此外, 即使在激光辅助 DCR 失败后, 次级外部 DCR 仍然可以执行, 没有困难。因此, 激光辅助 DCR 有资格作为一个可行的第二步的程序, 应最好地进行后再通手术失败和外部 DCR。

<table><tbody><tr><td>C1.multi</td><td>LUT</td><td>05.0082h.1</td><td>Endoscope camera</td></tr><tr><td>HL 250</td><td>LUT</td><td>95.2048n</td><td>Endoscope light source</td></tr><tr><td>MD-19E</td><td>ACL GmbH</td><td>1119</td><td>Endoscope screen</td></tr><tr><td>FOX (laser)</td><td>A.R.C. Laser GmBH, N&amp;uuml;rnberg, Germany</td><td>n/a</td><td>Diode laser</td></tr><tr><td>Laser fiber</td><td>A.R.C. Laser GmBH, N&amp;uuml;rnberg, Germany</td><td>LL13001s</td><td>Laser fiber</td></tr><tr><td>Laser handpiece</td><td>A.R.C. Laser GmBH, N&amp;uuml;rnberg, Germany</td><td>n/a</td><td>Handpiece</td></tr><tr><td>Wide Collarette Monoka</td><td>Fa. FCL, Paris, France</td><td>S1.1630</td><td>monocanalicular silicon tube</td></tr><tr><td>Suction elevatorium</td><td>Storz</td><td>474015</td><td>For intranasal use</td></tr><tr><td>Forceps (Gr&amp;uuml;nwald)</td><td>Storz</td><td>426620</td><td>For intranasal use</td></tr><tr><td>Forceps (Blakesley-Wilde)</td><td>Storz</td><td>456502</td><td>To grab the silicon tube</td></tr><tr><td>Lacrimal canula</td><td>Storz</td><td>81071</td><td>Blunt cannula</td></tr><tr><td>Bangerter probe cannula</td><td>Storz</td><td>81055</td><td>Bangerter probe cannula</td></tr><tr><td>Wooden spatula</td><td>any</td><td>n/a</td><td>Wooden spatula</td></tr><tr><td>Xylometazolin 0.05% eye drops</td><td>GlaxoSmithKline Consumer Healthcare</td><td>n/a</td><td>Decongestant eye drops</td></tr><tr><td>Dexapos comod eye drops</td><td>Ursapharm</td><td>n/a</td><td>steroid eye drops</td></tr><tr><td>Floxal eye drops</td><td>Dr. Gerhard Mann</td><td>n/a</td><td>antibiotic eye drops</td></tr></tbody></table>

transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction

今天的金标准在治疗 infrasaccal 原发性后天性鼻泪管阻塞 (潘多) 是外部泪囊鼻腔切除术 (DCR), 一个相对侵入的程序, 可以执行后, 失败的正值治疗。然而, 随着二极管激光技术领域的进步, 新的方法已经出现。激光辅助 transcanalicular DCR 与后续 bicanalicular 硅插管是一个新的选择, 显示了巨大的承诺作为一个可行的微创手术。在鼻腔的永久性内窥镜视觉控制下, 将一根二极管激光纤维插入泪囊, 应用激光能量在泪腺囊和鼻腔之间形成一个骨口。由于不需要做皮肤切口, 这种方法的优点包括皮肤的保留, 以及内侧眼睑结构和生理眼睑-小泵机构。手术时间和 reconvalescence 一般短于外 DCR。并发症包括硅胶管脱垂, 轻度肿胀, 很少, 小感染和热损伤。一年的功能成功率, 定义为完全解决症状和口通畅, 是高, 但仍然在后面的外部 DCR。但是, 在激光辅助 DCR 失败后的二次外部 DCR 可以毫不费力地进行。因此, 激光辅助 transcanalicular DCR 是一个有效的选择, 应考虑作为第二步的过程后, 再通程序的失败和外部 DCR。

最佳结果:
上述过程大约需要 10-25 分钟, 而且通常是很好的耐受。第二天检查后, 大约60% 的病例会出现眼睑肿胀。这种小肿块总是在最多三天内完全解决。患者不抱怨疼痛, 硅脱垂或受伤或感染的迹象。然而, 由于 bicanalicular 硅插管正在执行过程中, 溢可能坚持, 直到管被删除。局部应用抗生素, 甾体, 充血眼术后是必要的, 病人需?...

Watch this Scientific Journal Video about Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction at JoVE.com

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

本议定书的目的是提出 transcanalicular 激光辅助泪囊鼻腔吻合术作为一种微创方法治疗原发性后天性鼻泪管阻塞。

Transcanalicular 二极管激光辅助泪囊鼻腔吻合术治疗原发性鼻泪管阻塞

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

transcanalicular-diode-laser-assisted-dacryocystorhinostomy-for

Research

JoVE Journal

Medicine

10.9K 次观看.  University of Cologne. 本议定书的目的是提出 transcanalicular 激光辅助泪囊鼻腔吻合术作为一种微创方法治疗原发性后天性鼻泪管阻塞。

视频: Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Ultrasound Cyclo Plasty in Eyes with Glaucoma

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to severe visual impairment, and eventually blindness. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty (UCP), for reducing intraocular pressure (IOP) in glaucoma patients. The technique determines a selective coagulation necrosis of the ciliary body; in addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed. UCP shows several technical improvements in ultrasound technology compared to previous techniques, providing more precise focusing on the target zone. The procedure is performed in the operating room under peribulbar anesthesia. Briefly, the coupling cone is put in contact with the eye and the ring probe, that contains six piezoelectric transducers which produce the ultrasound beams, is inserted inside it. Their proper centering over the ocular surface represents a crucial step for the correct targeting of the ciliary body. Sterile balanced salt solution is used to fill the empty spaces to ensure ultrasound acoustic propagation. Surgical treatment consists in the sequential automatic activation of each of the six transducers, for a total duration of less than 3 min. The patient leaves the hospital 1 h after the procedure with the treated eye patched. In the present study, 10 patients with open-angle glaucoma were followed-up during at least 12 months after the procedure. IOP was reduced at each interval compared to pre-operative, as well as the number of hypotensive medications. Twenty percent of patients did not respond to the treatment, and needed subsequent surgery to better control IOP. Treatment tolerability was good, with no cases of hypotony or phthisis. The UCP procedure is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures with similar results in reducing IOP.

Glaucoma is a chronic disease with progressive degeneration of optic nerve fibers resulting in decreased visual field. Elevated intraocular pressure is considered the most important and the only treatable risk factor. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty, for reducing intraocular pressure in glaucoma patients.

青光眼眼中的超声环成形术

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to ...

科研

行为学

Surgical Induction of Endolymphatic Hydrops by Obliteration of the Endolymphatic Duct

Surgical induction of endolymphatic hydrops (ELH) in the guinea pig by obliteration and obstruction of the endolymphatic duct is a well-accepted animal model of the condition and an important correlate for human Meniere's disease. In 1965, Robert Kimura and Harold Schuknecht first described an intradural approach for obstruction of the endolymphatic duct (Kimura 1965). Although effective, this technique, which requires penetration of the brain's protective covering, incurred an undesirable level of morbidity and mortality in the animal subjects. Consequently, Andrews and Bohmer developed an extradural approach, which predictably produces fewer of the complications associated with central nervous system (CNS) penetration.(Andrews and Bohmer 1989) 
The extradural approach described here first requires a midline incision in the region of the occiput to expose the underlying muscular layer. We operate only on the right side. After appropriate retraction of the overlying tissue, a horizontal incision is made into the musculature of the right occiput to expose the right temporo-occipital suture line. The bone immediately inferio-lateral the suture line (Fig 1) is then drilled with an otologic drill until the sigmoid sinus becomes visible. Medial retraction of the sigmoid sinus reveals the operculum of the endolymphatic duct, which houses the endolymphatic sac. Drilling medial to the operculum into the area of the endolymphatic sac reveals the endolymphatic duct, which is then packed with bone wax to produce obstruction and ultimately ELH. 
In the following weeks, the animal will demonstrate the progressive, fluctuating hearing loss and histologic evidence of ELH.

This video shows how to surgically obstruct the guinea pig's endolymphatic duct to produce endolymphatic hydrops.

内淋巴管闭塞手术诱导的内淋巴积水

Surgical induction of endolymphatic hydrops (ELH) in the guinea pig by obliteration and obstruction of the endolymphatic duct is a well-accepted animal ...

生物学

Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits

Dry eye disease (DED) is a complex disease with multiple etiologies and variable symptoms, having ocular surface inflammation as its key pathophysiologic step. Despite advances in our understanding of DED, significant knowledge gaps remain. Advances are limited in part due to the lack of informative animal models. The authors recently reported on a method of DED induced by injecting all orbital lacrimal gland (LG) tissues with the lectin concanavalin A. Here, we report a novel model of aqueous-deficient DED based on the surgical resection of all orbital LG (dacryoadenectomy) tissues. Both methods use rabbits because of their similarity to human eyes in terms of the size and structure of the ocular surface. One week after removal of the nictitating membrane, the orbital superior LG was surgically removed under anesthesia, followed by removal of the palpebral superior LG, and finally removal of the inferior LG. Dacryoadenectomy induced severe DED, evidenced by a marked reduction in the tear break up time test and the Schirmer&#39;s tear test, and significantly increased tear osmolarity and rose bengal staining. Dacryoadenectomy-induced DED lasted at least eight weeks. There were no complications and animals tolerated the procedure well. The technique can be mastered relatively easily by those with adequate surgical experience and appreciation of the relevant rabbit anatomy. Since this model recapitulates the features of human aqueous-deficient DED, it is suitable for studies of ocular surface homeostasis, DED, and candidate therapeutics.

A novel approach is presented to induce chronic dry eye disease in rabbits by surgically removing all orbital lacrimal glands. This method, distinct from those previously reported, produces a stable, reproducible model of aqueous deficient dry eye well suited to study tear physiology and pathophysiology and ocular therapeutics.

在兔子中使用完全的白眼切除术建立严重干眼模型

Dry eye disease (DED) is a complex disease with multiple etiologies and variable symptoms, having ocular surface inflammation as its key pathophysiologic ...

医学

Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the main technical challenge of endoscopic middle ear surgery. The accompanying video describes the detailed protocol of a constant-suction bone-drilling technique and the procedure of endaural exclusive endoscopic atticoantrotomy (retrograde mastoidectomy) using this technique. The main components of this bone-drilling technique include a soft and flexible suction tube, which is placed into the tympanic cavity to provide constant suction, and a soft sleeve, which is wrapped around the drill shaft to prevent the high-speed rotating shaft from damaging the lens of the endoscope. With these simple modifications, the traditional otological electrodrill can be used for drilling a tiny endaural incision in endoscopic middle ear surgery. Based on this bone-drilling technique, endaural endoscopic atticoantrotomy (retrograde mastoidectomy) can be successfully established for the removal of various amounts of bone, depending on the extent of the lesion. The short-term postoperative outcome seems promising.

Endaural Endoscopic Atticoantrotomy Retrograde Mastoidectomy using a Constant Suction Bone-drilling Technique

In this paper, we present the protocol and short-term outcomes of endaural exclusive endoscopic atticoantrotomy using a constant suction bone-drilling technique.

使用恒定抽吸骨术的内窥镜下盂骨切开术（逆行切除术）

Endoscopic middle ear surgery is a widely employed minimally invasive surgical technique to address middle ear and mastoid pathology. Bone drilling is the ...

The Microscopic Transcanal Approach in Stapes Surgery Revisited

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision; however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space; however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.

This article describes the microscopic transcanal technique for stapes surgery, providing step-by-step surgical instructions for familiarizing surgeons with this approach.

重新审视镫骨手术中的显微经管入路

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the ...

Iris Fixation via External Pentagram Suturing

Extensive anterior synechia of the iris can result in the gradual disappearance of the anterior chamber. It is one of the most common outcomes of both oculopathy and complicated post anterior segment surgery. This can impact visual function and lead to bullous keratopathy, making it one of the most complex clinical problems. Conventional anterior chamber plasty will partially create the anterior chamber, but the anterior chamber disappears again in some cases. The main reasons are: (1) the iris lens diaphragm is loose with atrophied and tension-free iris so that the aqueous humor circulation will push and squeeze the iris forward; (2) the effect of "roller" formed in the process of inflammation or restoration will change the iris structure from peripheral anterior synechia (PAS) to extensive anterior synechia again; (3) the fibration will result in synechia from iris to the cornea. In such cases, corneal endothelium deficiency can't stop the aqueous humor from entering the cornea. This results in persistent corneal edema post-conventional anterior chamber plasty, resulting in progressive rubbing and lachrymation. Therefore, anterior chamber plasty is not the first choice for patients without surgical indications of Descemet's stripping automated endothelial keratoplasty (DSAEK). However, this can be performed in patients with surgical indications who plan to receive DSAEK. A unique method of iris fixation via external pentagram suturing anterior chamber plasty (PSACP) is described here. The present technique is also compared with the conventional anterior chamber plasty. PSACP and DSAEK might be an effective way to cure the bullous keratopathy with extensive anterior synechia of the iris and disappeared anterior chamber.

Iris Fixation via External Pentagram Suturing

The present protocol describes how a 10-0 polypropylene suture crosses the anterior surface of the iris, forming a pentagram to prevent both iris and pupil from moving toward the cornea. This can be combined with subsequent keratoplasty to cure bullous keratopathy with extensive anterior synechia of the iris.

虹膜通过外部五角星缝合固定

Extensive anterior synechia of the iris can result in the gradual disappearance of the anterior chamber. It is one of the most common outcomes of both ...

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

内淋巴管阻塞作为梅尼埃病的手术治疗选择

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...

Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because it offers a wide endoscopic view of the middle ear and a minimally invasive approach. The two main limitations are the loss of one operative hand and a narrow external auditory canal in younger children. Here, we present the case of a 3-year-old patient with a Potsic stage III congenital cholesteatoma adherent to the incus and branches of the stapes. A robotic-assisted TEES procedure was performed, during which a robotic arm with 6 degrees of freedom held a 0&#176;, 2.9 mm wide endoscope, enabling the surgeon to work in a narrow environment with both hands. The procedure's duration was 2 h and 9 min, including 16 min for the installation and draping of the robotic arm. After a trans-canal approach, the cholesteatoma was dissected from the ossicles using both a needle (or sickle knife) and suction to stabilize the ossicles and limit the risk of hearing trauma. The cholesteatoma was debulked to reduce its size, allowing it to be pushed under the malleus anteriorly and then separated from other adherences before removal. A tragal cartilage graft was used to reinforce the tympanic membrane.

This protocol describes the removal of congenital cholesteatoma using minimally invasive transcanal endoscopic ear surgery with a two-handed approach and a robotic endoscope holder.

机器人辅助经管内窥镜耳部手术治疗先天性胆脂瘤

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because ...

Nasolacrimal Lavage as a Treatment for Ocular Surface Toxic Soup Syndrome

Ocular surface toxic soup syndrome (OSTSS) is characterized by inadequate tear drainage through the nasolacrimal duct system, leading to the accumulation of inflammatory mediators in the tear film. This condition can result in toxic keratoconjunctivitis, with symptoms such as conjunctival hyperemia, itchiness, discomfort, and epiphora. Dilation and irrigation are common diagnostic procedures in both optometry and ophthalmology, used to assess nasolacrimal duct obstruction in cases of epiphora. This technique involves the injection of saline into the nasolacrimal duct system through the puncta, followed by the evaluation of reflux, which indicates obstruction. Although intended to be diagnostic, many patients report significant improvements in epiphora and ocular comfort after the procedure. In this paper, we present a case study in which a patient achieved complete resolution of epiphora and itchiness following therapeutic nasolacrimal lavage performed every 2 months. Subjective improvements in symptoms in 3 additional patients are also reported. We propose nasolacrimal lavage not only as a diagnostic tool but also as an effective therapeutic intervention for managing OSTSS.

OSTSS leads to pooled inflammatory mediators in the tear film, causing symptoms like epiphora and discomfort. Here, we present a case where therapeutic nasolacrimal lavage every 2 months resolved epiphora and itchiness, suggesting its efficacy as a therapeutic intervention for OSTSS. Additionally, we report subjective improvements in symptoms in 3 additional patients.

Ocular surface toxic soup syndrome (OSTSS) is characterized by inadequate tear drainage through the nasolacrimal duct system, leading to the accumulation ...

Superior Lacrimal Gland Removal: A Surgical Technique to Remove the Palpebral and Orbital Parts of Superior Lacrimal Gland from Rabbit Model

Source: Honkanen, R. A. et al., <a href="https://www.jove.com/v/60126">Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits.</a> J. Vis. Exp. (2020).
This video describes the surgical procedure to remove the two parts: palpebral and orbital of the superior lacrimal gland from a rabbit to create a dry eye disease model. This rabbit model is suitable for studies of ocular surface homeostasis, pathophysiology and ocular therapeutics.

泪腺上部切除术:一种从兔子模型中去除泪上腺睑部和眼眶部分的手术技术

Source: Honkanen, R. A. et al., Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits. J. Vis. Exp. (2020).
This video ...